Multimorbidity and access to social care: exploiting emerging administrative data sources in Scotland

Introduction: Children who have been in out-of-home care have faced significant issues during their lives, and they are considered one of the most vulnerable groups in society. Given the limited evidence in Western Australia about outcomes for care-leavers, this study represents a base line for future studies of care-leavers outcomes. Objectives and Approach: A retrospective cohort study exploring the outcomes for young people born between 1990-1995, who have reached at least 18 years of age and have had a period of care, compared to other similar children in WA. This project used administrative linked data from the Department of Communities Child Protection and Family Support Division, Departments of Health, Education, and Corrective Services. This study undertook a descriptive approach to compare outcomes for young people who have left out-of-home care, and logistic regression modelling to explore the odds of having poorer outcomes among those who had a period in care. Results: Young people aged 18 years and over who had been in out-of-home care had worse outcomes compared to controls. Care-leavers had nearly twice the hospital admission rate of those who never had contact with the child protection system, almost three times more likely to have a mental health related contact, less likely to achieve a high school completion certificate and attend University, and more likely to have a juvenile community sentence or adult detention. A group of young people who had a period in care were identified as more likely to have ‘poorer outcomes’ compared to the rest of the Care group if they: were Aboriginal; female; born in a more disadvantaged area; and first entered care after the age of 10. Conclusion/Implications: Young people who have been in care are at high risk of a range of poor outcomes, even compared to other children who have experienced similar disadvantage. Regardless of the causes, it is incumbent upon the State as acting ‘parents’ to provide the best possible support to improve their outcomes

Match-play, training workloads and sensorimotor and neuromuscular performance of elite young soccer players

Nigel Gleeson - ORCID: 0000-0003-0072-1521 https://orcid.org/0000-0003-0072-1521Purpose: The purpose of this study was to assess sensorimotor and neuromuscular performance capabilities over an in-season microcycle in early-career professional soccer players and to examine the relationship with training and match-play workload. Methods: Sensorimotor and neuromuscular performance capabilities (isometric knee extensor: force replication error, peak force, electromechanical delay, rate of force development) of 12 professional soccer players were assessed over a 7-day period. Training and match-play workload was also recorded over the same period for each player (high-intensity running distance). Fluctuations in sensorimotor and neuromuscular performance and workload variables were analysed. Results: There was evidence of fluctuations in sensorimotor and neuromuscular performance capability over the microcycle that reached statistical (p < .005) and practical (18.1% [baseline-to-peak]) significance alongside heterogeneity in training and match workload (264% [coefficient of variation], p < .0005). Some temporal congruence among fluctuating patterns of intra-microcycle training and match-play load and concomitant electromechanical delay performance was noted (p < .005). Asynchronous responses were observed for peak force, but rate of force development and force replication error capabilities were unchanged during the microcycle. Conclusion: While some neuromuscular performance capabilities fluctuate over an in-season microcycle and are influenced partially by high-intensity running workload, sensorimotor performance capabilities were unchanged during the microcycle.https://doi.org/10.55860/RIIE10933pubpub

Tragic but brave or just crips with chips? Songs and their lyrics in the Disability Arts Movement in Britain

Disability culture is a site within which social and positional identities are struggled for and dominant discourses rejected; in which mainstream representations of people with impairments – as victims of personal tragedy – are held to the light and revealed as hegemonic constructions within a disabling society. Drawing upon styles that range from jazz, blues and folk to reggae, performance poetry and punk, disabled singers and bands in the Disability Arts Movement in Britain have been central to the development of an affirmative disability discourse rooted in ideas of pride, anger and strength. Examining lyrics by Johnny Crescendo, Ian Stanton and the Fugertivs – performers emerging as part of this movement in the 1980s and 1990s – this article considers the dark humour which runs through much of this work. It is suggested that these lyrics' observational reflections on everyday experiences of being oppressed as disabled people have been overlooked within critical disability studies to date, but are important in developing an understanding of positive disability identity as a tool available to disabled people in order to make sense of, and express themselves within, the world in which they find themselves

Sunbeams from Space Mirrors Feeding Solar Farms on the Ground at Dusk and Dawn

For 40 years, the systems designers of space solar power have given their greatest attention to wireless power as microwave transmission from space to earth. The approach taken in this application is to place space satellites in lower sunsyncronous orbits for the purpose of gathering and focusing sun’s rays into a beam of reflected sunlight. The simple idea and application of this design is to extend the solar day of terrestrial solar farms, thereby increasing solar production capacity to 60 percent and reducing solar electricity costs to under 6 cents/kWh by delivering sunlight to a given location some 14 (rather than 6 or 7) hours per day. Advisors: Lewis Fraas, Prof. Don Flournoy, Kyle Perkins Reflected Sunlight from Space Journal on Vimeo

Multimorbidity and access to social Care: exploiting emerging administrative data sources in Scotland.

Introduction Integration of health and social care services is a potential solution to improving care despite budgetary constraints and increased demand for services. Little is known about how having two-or-more long-term conditions (multimorbidity) and socioeconomic status affect social care use, or how all these factors affect unscheduled health care use. Objectives and Approach The project aims to describe the demographic, geographic, and socioeconomic differences in the receipt of social care for over 65s in Scotland and how multimorbidity status influences amounts of social care received. Additional analyses will consider the influence receipt of social care has on use of unscheduled health care services and mortality. Social Care Survey (SCS) data collected by the Scottish Government is linked to administrative health and mortality records. Linkage includes; prescribing information service and USC data which records episodes of A & E attendance, emergency admission to hospital, GP out-of-hours attendance, Scottish Ambulance Service use, and NHS24 contact Results The cohort includes 1.1million individuals over the age of 65 (54.8% Female), of which 274,011 (24.2%) people died during the study period. The linkage rate of the SCS to records with a CHI number in the National Records of Scotland population spine was 90.5%, with one local authority removed for very low linkage rates and the remaining 31 with rates between 76.7% and 97.9%. As of February 2018, all requested data has been transferred to the National Safe Haven and data cleaning and analysis has begun. Significant results are expected to have been produced by August 2018. Conclusion/Implications This research will help understand if receipt of social care is equitably distributed among the population of Scotland after allowing for multimorbidity and socioeconomic status. Understanding the influence health status has on social care receipt and the influence social care has on unscheduled healthcare use has important implications for policy development

Validation of the Scottish Social Care Survey using data from Renfrewshire Council

Background: The Social Care Survey (SCS) is collected annually by the Scottish Government (SG) from all of Scotland’s 32 local authorities. In addition to other information, it details the amount of home care delivered to all individuals in receipt of this service during a specified census week. How well this census represents care delivered throughout the year is unknown. Objectives: Using complete data from one local authority area: 1. Quantify the annual proportion of individuals receiving care during the census week. 2. Describe differences in type and duration of care packages received during/not during the census week. Methods: A data sharing agreement was completed with Renfrewshire council to transfer all social care data for the years 2006-2016 to a safe haven environment. A time series was created identifying how much care each individual received at weekly intervals during the study period allowing comparison of counts of individuals at any given week with total counts for financial years. Differences in packages received during/not during the census week in each financial year were compared using the Mann-Whitney U test. Findings: 41,002 packages of home care for 10,130 individuals over the age of 65 (64% female), were analysed. The proportion of people receiving care in the census week varied from 54.1% to 64.8% of the total number of individuals receiving care in a given financial year. Approximately half of packages received during the census week were of similar duration and intensity (weekly hours delivered) as packages not captured by the census. The remainder tended to be of much longer duration (&gt;1 year) and less intensity. Conclusions: The SCS represents approximately 60% of individuals receiving home care in the Renfrewshire council area and a representative sample of packages of care delivered

Primary care transformation in Scotland:qualitative evaluation of the views of patients

BackgroundThe new Scottish GP contract introduced in April 2018 aims to improve quality of care through expansion of the multidisciplinary team (MDT) to enable GPs to spend more time as expert medical generalist with patients with complex needs.AimTo explore patients’ views on the changes in general practice in Scotland since the inception of the new contract.Design and SettingQualitative study with 30 patients (10 living in urban deprived areas, 10 living in urban affluent/mixed urban areas, and 10 living in remote and rural areas).MethodsIn-depth semi-structured interviews with thematic analysis. ResultsPatients were generally unaware of the new GP contract, attributing recent changes in general practice to the COVID-19 pandemic. Ongoing concerns included access to GP consultations (especially face-to-face ones), short consultation length with GPs, and damage to continuity of care and the GP-patient relationship. Most patients spoke positively about consultations with MDT staff but still wanted to see a known GP for health concerns that they considered potentially serious. These issues were especially concerning for patients with multiple complex problems, particularly those from deprived areas. ConclusionFollowing the introduction of the new Scottish GP contract, patients in our sample were accepting of first contact care from the MDT but still wanted continuity of care and longer face-to-face consultations with GPs. These findings suggest that the expert generalist role of the GP is not being adequately supported by the new contract, especially in deprived areas, though further quantitative research is required to confirm this. Key words: Primary care transformation, reform, GP contract, patients’ views, multimorbidity, deprivation<br/

Linkage of national health and social care data: a cross-sectional study of multimorbidity and social care use in people aged over 65 years in Scotland

Background: Little is known about the relationship between multimorbidity and social care use (also known as long-term care). The aim of this study was to assess the relationship between receipt of formal social care services and multimorbidity. Methods: This retrospective data linkage, observational study included all individuals over the age of 65 in the population of Scotland in financial years 2014/15 and 2015/16 (n= 975,265). The main outcome was receipt of social care measured by presence in the Scottish Social Care Survey. Logistic regression models were used to assess the influence of multimorbidity, age, sex, and socioeconomic position on the outcome reporting Average Marginal Effects (AME). Findings: 93.3% of those receiving social care had multimorbidity. 16.2% of those with multimorbidity received social care compared to 3.7% of those without. The strongest magnitudes of AME for receiving social care were seen for age and multimorbidity (respectively 50% and 18% increased probability comparing oldest to youngest and most severe multimorbidity to none). A 5.5% increased probability of receiving social care was observed for the most-deprived compared to the least-deprived. Interpretation: Higher levels of social care receipt are observed in those with increasing age, severe multimorbidity and living in more deprived areas. Multimorbidity does not fully moderate the relationship between social care receipt and either age or deprivation

The relative importance of frailty, physical and cardiovascular function as exercise-modifiable predictors of falls in haemodialysis patients: A prospective cohort study

From PubMed via Jisc Publications RouterTobia Zanotto - ORCID 0000-0002-6571-4763 https://orcid.org/0000-0002-6571-4763Marietta van der Linden - ORCID 000-0003-2256-6673 https://orcid.org/0000-0003-2256-6673Stage 5 chronic kidney disease (CKD-5) patients on haemodialysis (HD) are at high risk of accidental falls. Previous research has shown that frailty is one of the primary contributors to the increased risk of falling in this clinical population. However, HD patients often present with abnormalities of cardiovascular function such as baroreflex impairment and orthostatic dysregulation of blood pressure (BP) which may also be implicated in the aetiology of falling. Therefore, we aimed to explore the relative importance of frailty and cardiovascular function as potential exercise-modifiable predictors of falls in these patients. Ninety-three prevalent CKD-5 patients on HD from three Renal Units were recruited for this prospective cohort study, which was conducted between October 2015 and August 2018. At baseline, frailty status was assessed using the Fried's frailty phenotype, while physical function was evaluated through timed up and go (TUG), five repetitions chair sit-to-stand (CSTS-5), objectively measured physical activity, and maximal voluntary isometric strength. Baroreflex and haemodynamic function at rest and in response to a 60° head-up tilt test (HUT-60°) were also assessed by means of the Task Force Monitor. The number of falls experienced was recorded once a month during 12 months of follow-up. In univariate negative binomial regression analysis, frailty (RR: 4.10, 95%CI: 1.60-10.51, p = 0.003) and other physical function determinants were associated with a higher number of falls. In multivariate analysis however, only worse baroreflex function (RR: 0.96, 95%CI: 0.94-0.99, p = 0.004), and orthostatic decrements of BP to HUT-60° (RR: 0.93, 95%CI: 0.87-0.99, p = 0.033) remained significantly associated with a greater number of falls. Eighty falls were recorded during the study period and the majority of them (41.3%) were precipitated by dizziness symptoms, as reported by participants. This prospective study indicates that cardiovascular mechanisms implicated in the short-term regulation of BP showed a greater relative importance than frailty in predicting falls in CKD-5 patients on HD. A high number of falls appeared to be mediated by a degree of cardiovascular dysregulation, as evidenced by the predominance of self-reported dizziness symptoms. ClinicalTrials.gov (trial registration ID: NCT02392299; date of registration: March 18, 2015).This work was supported by a British Kidney Patient Association – British Renal Society joint grant (BKPA-BRS grant number: 16–003). The funders of this study had no role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.21pubpu